Abstract：
OBJECTIVE:In chronic heart failure (HF), diuretic doses increase as the disease progresses, often after hospitalization for instability, and have been associated with worsening renal function and increased mortality. METHODS AND RESULTS:A prospective observational analysis of 183 patients in an advanced HF clinic stratified at baseline by diuretic dose (low dose < or = 80 mg, high dose > 80 mg furosemide equivalent) was performed. All patients were followed for 1 year, and the primary outcome was a combined HF event of admission for HF, cardiac transplant, mechanical cardiac support, or death. Compared with patients taking low-dose diuretics (n = 113), patients taking high-dose diuretics (n = 70) had more markers of increased cardiovascular risk and were more likely to have a history of recent instability (33% vs 4.4% in low dose, P < .001). High doses of diuretics were a strong univariate predictor of subsequent HF events (hazard ratio 3.83, 95% confidence interval 1.82-8.54); however, after adjustment for clinical stability, diuretic dose no longer remained significant (hazard ratio 1.53, 95% confidence interval 0.58-4.03). CONCLUSION:High-dose diuretics may be more of a marker than a cause of instability. A history of HF stability during the past 6 months is associated with an 80% lower risk of an HF event during the next year, independently of baseline diuretic dose.
journal_name
J Card Failjournal_title
Journal of cardiac failureauthors
Mielniczuk LM,Tsang SW,Desai AS,Nohria A,Lewis EF,Fang JC,Baughman KL,Stevenson LW,Givertz MMdoi
10.1016/j.cardfail.2008.01.015subject
Has Abstractpub_date
2008-06-01 00:00:00pages
388-93issue
5eissn
1071-9164issn
1532-8414pii
S1071-9164(08)00043-2journal_volume
14pub_type
杂志文章abstract：BACKGROUND:Studies have shown that neither ejection fraction nor hemodynamic abnormalities during exercise in chronic heart failure (HF) correlate with symptoms of fatigue and exhaustion. The concept that exercise limitation in patients with chronic HF is due to abnormal hemodynamics during exercise has been revised to...
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pub_type： 杂志文章,实务指引
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pub_type： 临床试验,杂志文章
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更新日期：1999-12-01 00:00:00
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journal_title：Journal of cardiac failure
pub_type： 杂志文章
doi：10.1016/j.cardfail.2008.04.005
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pub_type： 杂志文章,评审
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journal_title：Journal of cardiac failure
pub_type： 杂志文章
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更新日期：2010-04-01 00:00:00
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journal_title：Journal of cardiac failure
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